A platform for collaborative editing of efficient, evidence-based medical dotphrases and templates.
WHAT IS A DOTPHRASE?
A dotphrase is a colloquial term for a preformed block of text that is inserted using keyboard shortcuts, often preceded by a dot. For example ".LBP" might pull in a block of text related to low back pain. Most EHRs have this capability, both for organization-level and individual user-created content.
CHALLENGES OF CURRENT PRACTICE ENVIRONMENT
Documentation is inefficient, arduous and not evidence-based. Providers spend more time documenting than seeing patients and are frustrated with the status quo. Dotphrases have the potential to achieve improved efficiency and evidence-based care while reducing provider burnout.
CHALLENGES WITH CURRENT DOTPHRASE USE
Most dotphrases in use today are one-offs made by individuals with many limitations:
They lack evidence base or peer review.
They are siloed in individual users' accounts, not easily accessible to wider communities for use or collaborative editing.
They are difficult to organize or recall.
OPPORTUNITIES: WHY USE DOTPHRASES?
POINT OF CARE DECISION SUPPORT
A dotphrase can function as a decision support tool, efficiently bringing relevant, evidence-based information into the clinical encounter, at the exact time that key management decisions are made and diagnostics/therapeutics ordered (eg, should I prescribe antibiotics for sinusitis or order a spine MRI for back pain?).
Clinicians find documentation overly burdensome, taking time from direct patient care. Yet, high quality, complete notes serve a variety of purposes including communication with other providers as well as meeting medical-legal and billing requirements. Thoughtfully designed dotphrases can help fulfill all of these functions while maximizing time with patients.
Well-crafted dotphrases can serve as a succinct learning opportunity for trainees. They can highlight important elements in evaluation of particular complaints and externalize expert clinicians' implicit algorithms. They can serve as a useful hedge against cognitive errors, for example reminding clinicians to consider less common diagnoses and avoid premature closure.
LEARNING FROM OUR COMMUNITY
Input from the community of clinical end-users is critical as we strive for continuous improvement in the quality and breadth of dotphrases. Community members will be able to propose and debate changes to the structure of the site itself (e.g, navigation, layout, filters, tags). In addition to generating high quality dotphrases, we also seek to learn how to support collaborative curation of medical knowledge.
QUALITY OVER QUANTITY
This site will strive for high quality, evidence-based dotphrases. Channeling the input of the community, section editors will curate topics with the goal of defining a single "gold-standard" dotphrase (rather than many competing dotphrases for each topic). Community members will be able to propose new dotphrase which can replace or be merged into the existing gold standard.
We will also solicit "Chalk talks" or brief educational resources usually used to teach medical students or residents clinically relevant material. The ideal way to share these on this site is by uploading a picture of a completed talk. If you would like to quickly post a Chalk talk from your phone, email your photo to firstname.lastname@example.org along with your name and the topic of the talk.
PATRICK SANGER, MD PhD
I'm a 3rd year internal medicine resident in the UCPC primary care track at UCSF. I've had a long-standing interest in leveraging technology to improve healthcare which resulted in pursuing an MD/PhD in biomedical informatics at the University of Washington. During medical school, graduate school and especially residency, I found a lack of tools which allow structured knowledge sharing in the medical community. Dotphrases were an especially egregious example: I and my co-residents created haphazard one-offs year after year; sharing within our EHR was impractical and collaborative editing was impossible. This site was born out of a hope that we can do better.
NAT GLEASON, MD
Dr. Gleason is Associate Professor of Clinical Medicine in the Division of Internal Medicine where he practices as a primary care physician and teaches medical students and residents. He serves as Medical Director for Practice Innovation for UCSF Health, focusing innovations that improve access to timely, high-value care in the outpatient setting.
Section editors wanted
If you're interested in helping to manage the site or be a section editor, let us know (email email@example.com). If you'd like to contribute content, you can sign up on this page.
Suggestions (not requirements):
1. Your dotphrase can contain any/all of Subjective (S), Objective (O), Assessment/Plan (AP), Clinical education (ED), Patient Info (PI), or Admin/Other (AO). It can address a known diagnosis or an undifferentiated complaint. Encourage focusing on Assessment/Plan since this is the most challenging and not many existing dotphrases cover this.
2. Please include evidence where appropriate, e.g.:
for Subjective and Objective elements, cite likelihood ratios (preferred) or sensitivity/specificity
for Assessment/Plan, cite NNT/NNH for treatments and/or clinical decision rules
include links to shared decision aids
3. Write text in such a way as it can be directly used without editing, (eg, "The patient denied x, y, z" rather than "x, y, z?")
4. If S/O/AP have significant branch points, (eg, micro/normo/macrocytic anemia), indicate that and write separate text that is appropriate to each with the understanding that the other branches' text can be deleted.
5. For plans, try to include first, second and/or third line workup.
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